Kaiser Daily Global Health Policy Report

In The News

“Delegates to the World Trade Organization [WTO] meeting in Bali, Indonesia, have approved a global trade deal for the first time since the organization was founded in 1995,” VOA News reports. “The deal still must be approved by all 159 member governments,” the news service notes, adding, “Analysts estimate that the deal will add $1 trillion to the world economy and say it preserved the future of the WTO” (12/7). “The talks almost collapsed as the result of a battle between India and the U.S. and E.U. over how WTO rules should be applied to government programs to buy staples from subsistence farmers and provide food to the poor,” the Financial Times writes (Donnan, 12/7). “India’s plans are currently against WTO rules, as such subsidies could distort global food prices,” the Wall Street Journal states, adding, “But negotiators, including the U.S., agreed to give India time to develop alternatives, a process that will take years and has no deadline” (Otto, 12/8). U.S. President Barack Obama lauded the agreement, but some humanitarian groups “said the accord produces few gains for the poor, while farm groups in the U.S. — the world’s biggest agricultural exporter — had little reaction,” Bloomberg writes (Bjerga, 12/8).

Media outlets continue to examine the HIV/AIDS work of Nelson Mandela, who died at the age of 95 on Thursday. “As the world mourns the passing of Nelson Mandela, some observers are recalling the crucial role he played in advocating for science during the highly fraught AIDS crisis in South Africa,” ScienceInsider reports. However, “[d]uring his own presidency, he gave relatively little attention to the rapidly growing epidemic and put Thabo Mbeki [who would succeed him in office and who ‘rejected the scientific consensus and espoused the discredited view that HIV does not cause AIDS,’] in charge of dealing with it,” the news service notes (Benderly, 12/8). Craig Timberg of the Washington Post in a video report “discusses the former South African president’s hesitation to acknowledge the HIV epidemic spreading across Africa, which cost Mandela both politically and personally” (12/6).

IRIN writes, “It was only once he had left office that he grew much more vocal and active in the fight against HIV/AIDS, and his involvement inspired scientists, activists and other political leaders to do more, noted Robert Soudré,” the chair of the 17th International Conference on AIDS and STIs in Africa, taking place in Cape Town, South Africa, this week (12/9). Mandela “went on to later galvanize governments to declare a global AIDS emergency and pushed for antiretroviral drugs in South Africa, according to Agence France-Presse,” the Huffington Post’s “Impact” blog states, adding, “He also supported HIV/AIDS research and support for AIDS orphans through the Nelson Mandela Foundation and the Nelson Mandela Children’s Fund” (Prois, 12/7). Devex summarizes development leaders’ statements on Mandela’s life and work (Igoe, 12/6).

“French troops on Monday began disarming fighters in the Central African Republic after a swell in sectarian violence that has claimed hundreds of lives and terrified inhabitants,” Agence France-Presse reports (Cariou, 12/9). “A 1,600-strong French force has been sent into the CAR, deployed after days of communal fighting claimed 400 lives,” BBC News writes, noting, “The CAR has been in turmoil since March when an alliance of rebels, known as Seleka, seized power” (12/9). The conflict “has left half the population of 4.6 million in need of assistance, some 415,000 people displaced and countless living in fear of increasingly brutal and sectarian violence,” according to IRIN, which examines the challenges aid agencies working to provide humanitarian assistance are facing (12/6). The Thomson Reuters Foundation examines a rise in the use of child soldiers in the conflict, noting the number “has surged since the outbreak of the conflict in 2012 to between 3,500 and 6,000, [UNICEF] said on Friday” (Kehoe, 12/6).

“Hong Kong’s Center of Health Protection said Saturday authorities have quarantined 19 people that had come in contact with a H7N9 bird flu victim,” Forbes reports (Flannery, 12/8). Most of those quarantined have tested negative for the virus, “with the results of one patient pending,” Deutsche Welle writes, noting “Hong Kong [on Friday] confirmed its second human case of H7N9 bird flu, five days after its first” (12/7). “After the first H7N9 case was discovered in Hong Kong …, local health officials tightened infection controls at hospitals and limited visiting hours, while strictly enforcing cleaning rules at live chicken stalls in local markets,” according to the New York Times, which adds, “Hong Kong also said it planned to step up health checks at its borders to screen visitors for the virus” (Gough, 12/7). “Extra health officials have been deployed to carry out random temperature checks at entry points to the southern Chinese city, which already have thermal imaging systems,” Agence France-Presse writes, noting, “Suspected cases of avian influenza would immediately be referred to public hospitals” (12/6).

“Food aid is a global business that millions depend on, from the typhoon-stricken Philippines to war-torn Syria. Yet when it comes to the sourcing of this aid, there’s a growing debate on how much food should be bought locally,” versus shipped from the donor country, the Christian Science Monitor reports, examining how “[b]oth approaches come with trade-offs.” “The U.S. is the largest player in food aid: With $1.4 billion in 2013, it accounts for 36 percent of contributions to the United Nations World Food Programme,” the newspaper writes, adding, “However, it is the only major food aid donor to tie such a large share of its food aid to domestic interests. Other donors such as the European Union and Japan grant flexibility to buy food locally” (Kordunsky, 12/7).

The Guardian examines the issues of gender equality and women’s empowerment with respect to the global development agenda. “The Millennium Development Goal on gender set out to promote gender equality and empower women, with a target of eliminating gender disparity in all levels of education no later than 2015,” the newspaper writes, noting, “Indicators focused on ratios in education and literacy, wage employment and national parliaments.” The Guardian continues, “While MDG3 has helped boost political will, and encourage more development groups to invest in resources to promote women’s equality, broad progress towards gender equality has wavered, with persistent gender-based inequalities in health, education and politics around the world.” The newspaper includes quotes from U.N. Women Deputy Director John Hendra, “who spoke to the Guardian’s Global Development Professionals Network at the European Development Days in Brussels recently, [and said] the next development framework will need to tackle structural inequalities if it is to succeed where the current MDGs have fallen short” (Scott, 12/6).

“New research suggests that some AIDS patients [in Africa] are developing drug intolerance and severe side effects and will now have to switch to new, more expensive antiretroviral regimens,” Inter Press Service reports. “Researchers in Zimbabwe, Uganda, Nigeria and Malawi say some patients on the first-line antiretroviral drugs nevirapine and efavirenz (EFZ) are showing signs of being intolerant to the two drugs,” the news service writes, noting they reported their findings at the 17th International Conference on AIDS and STIs in Africa taking place in Cape Town, South Africa. “The challenge of paying for this expanded treatment coverage is complicated by the possibility that some patients will need different medication,” IPS writes, adding, “Further research to determine both the causes and extent of drug intolerance is called for” (Banda, 12/9).

Inter Press Service examines HIV/AIDS among youth in Africa, writing, “This is the only group where AIDS-related deaths have increased” and “[t]he rise in AIDS-related deaths among youth shows that they are falling through the cracks of HIV programs mainly designed for adults or children.” The article profiles Maureen Phiri, a young AIDS activist in Malawi, and includes comments from Gabriel Anabwani, executive director at the Baylor Children’s Clinical Centre of Excellence in Gaborone, Botswana; Rick Olson, senior HIV prevention specialist for UNICEF in East and Southern Africa; Specioza Wandira-Kazibwe, the U.N. secretary general’s special envoy for HIV/AIDS in Africa; and Steven Allen, UNICEF’s regional director for Central and East Africa (Schwikowski, 12/6).

GlobalPost’s “Pulse” blog examines Ghana’s success in reducing its mother-to-child HIV transmission rate, saying some of the factors include support from PEPFAR and “a government arm that is exclusively dedicated to responding to the HIV/AIDS epidemic.” In addition, “Ghana’s infant infection prevention programs, like most in west and central Africa, are multifaceted” and include care for infants and mothers, the blog writes (Stuart, 12/6).

The news that “HIV has reappeared in the blood of two Boston patients who scientists had hoped had been cured of their infections … is yet another cautionary tale of how researchers can never afford to underestimate the human immunodeficiency virus’s ability to hide out in patients’ bodies and overcome their most ingenious efforts to eliminate it,” NPR’s “Shots” blog reports (Knox, 12/6). “The patients had received a treatment regimen similar to that given to Timothy Ray Brown, known as the ‘Berlin patient,’ who doctors said in 2009 had been cured of the virus by a bone-marrow transplant with cells that were resistant to HIV infection,” Nature/Scientific American writes, noting, “Unlike Brown, however, the two ‘Boston patients’ … received bone-marrow transplants with cells that were not resistant to HIV” (Hayden, 12/8).

“Although there was never an expectation that risky bone-marrow transplants would soon be a routine treatment for HIV, the news was frustrating to AIDS experts,” the New York Times reports. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, “said the failure ‘doesn’t put an end to this avenue of research, but it certainly does put a damper on it,'” the newspaper writes (McNeil, 12/6). “Other people, including a child who is currently 36 months old and a group of 14 patients in France, have been able to go off antiviral drugs without the virus reappearing (so far) if they get treatment early enough after first being infected,” Business Insider notes (Welsh, 12/6).

Editorials and Opinions

“A core component of women’s rights is ensuring that all women — regardless of religion, nationality, or income level — have access to quality health care,” Rep. Karen Bass (D-Calif.) writes in the Huffington Post’s “Women” blog. “Recognizing the key link between health care for mothers and the impact on the social and economic fabric of countries, the United Nations included within the Millennium Development Goals the desire to reduce by 75 percent by 2015 the mortality rate for mothers from what it was in 1990 and to achieve by 2015 universal access to reproductive health for all the world’s women,” she notes. “We have made giant strides since 2000, but we still have important and necessary work to do,” she adds.

“As the Ranking Member of the House Subcommittee on Africa, I have the unique opportunity to address issues facing African women, and we need to face the hard facts about the health of mothers in sub-Saharan Africa,” Bass writes, adding, “To decrease the number of women dying in Africa we must increase both access to contraception and to health care providers.” She continues, “For me, ensuring that women have the ability to plan their families and their lives is a basic and fundamental human right. … Moving forward the international community must continue to focus on expanding access to family planning and work to ensure that no matter where a woman gives birth they can safely welcome their child into the world” (12/6).

“On [December 2] at the White House, President Obama reported the latest accomplishments of the U.S. government’s response to HIV,” AVAC Executive Director Mitchell Warren writes in the Huffington Post’s “Impact” blog, stating, “The progress he cited was impressive.” However, “there was little mention of one the most impressive turnarounds in the global response to AIDS,” he notes, adding, “By the end of this year, PEPFAR reports that it will have supported 4.7 million voluntary medical male circumcisions (VMMC), meeting a goal the president announced in 2011.” He writes, “The turnaround shows that setting ambitious targets — and backing them up with funding and political leadership — can have a transformational effect.”

“That achievement cannot, of course, be entirely chalked up to a numerical target, or even to an influx of funding. In the past year, several African countries themselves have established rollout plans and made substantial investments of their own,” Warren continues, adding, “But having a clear global objective was instrumental.” He states, “Even with this impressive success, we remain a long way from where we need to be,” and writes, “As we pass the targets that PEPFAR set for itself two years ago, it’s time to establish new goalposts. PEPFAR — and, for that matter, other global health leaders — must commit to achieving much more ambitious targets over the next two years.” He concludes, “By continuing to build our knowledge through clinical and early stage research for a cure, AIDS vaccines, microbicides and other [treatment]-based prevention, we lay the groundwork for the next generation of advances, and for the AIDS-free generation that we all hope to achieve” (12/6).

In a Globe and Mail opinion piece, Canadian researcher, writer and activist Gerald Caplan examines progress in the AIDS response since the early days of the disease, and he highlights a list of “challenges and misunderstandings” that remain today. “Although much is being done on the AIDS front, somehow there is never as much money available as experts deem necessary,” he states, adding, “It’s a tired old story and it’s hardly ever about scarcity. As always, it’s about political will and priorities.” He notes the Global Fund to Fight AIDS, Tuberculosis and Malaria last week received pledges of $12 billion, short of its replenishment goal of $15 billion, and he states the difference in funding means “life and death for countless Africans.”

“In Canada, knowledgeable civil society groups argued that this country’s fair share for the Global Fund should be $750 million; the government offered $650 million, or about $215 million a year,” Caplan continues. “Julio Montaner, a Canadian universally recognized for his expertise on HIV and AIDS, argues that ‘The government of Canada’s leadership in the fight against HIV/AIDS is long overdue,'” Caplan notes, concluding, “After this week, it still is” (12/6).

“On December 10, 2013, the world will mark the 20th year of Human Rights Day. Yet the rights of the world’s children caught in armed conflicts continue to be violated with impunity,” Siddharth Chatterjee, chief diplomat at the International Federation of the Red Cross and Red Crescent Societies, writes in a Forbes opinion piece, asking, “Who is protecting the rights of these children?” He details the situation in Syria, saying it “is a microcosm of the tyranny of violence children face worldwide.” He notes, “Spurred by the United States and Russia, Syria’s groups are now preparing to meet in Geneva in January 2014 for talks on bringing about a peace.” Chatterjee continues, “Preventing further violence against children must be on the top of the agenda for this meeting. It is up to various powers to ensure this and deliver a united message to all sides of the conflict that violence against Syria’s children will not be tolerated” (12/6).

Noting the Millennium Development Goals (MDGs) “are nearing their expiration date in 2015,” Yael Velleman, senior policy analyst for health and sanitation at WaterAid, writes in a Devex opinion piece, “We need to better coordinate our health response post-2015. Setting separate targets on nutrition, water and sanitation have fragmented our efforts. The separation of funding means we cannot meet people’s overall needs.” Better integration “will require a fundamental change in the way health is addressed and the aid architecture that supports it. It requires health funders to spend not just on immediate medical interventions to prevent and treat disease, but also on addressing the causes,” she continues, concluding, “If the post-2015 framework is to achieve greater success in the area of improving global health, we must keep our eyes focused on long-term, big-picture impact” (12/6).

The following is a summary of two opinion pieces addressing the AIDS work of Nelson Mandela, who died on Thursday at the age of 95.

Art Caplan, NBC News: “As the world mourns the passing of Nelson Mandela, it is important to look at the one area where the iconic former president of South Africa slipped — AIDS,” Caplan, the head of the Division of Medical Ethics at NYU Langone Medical Center, writes. “The most outstanding moral figure of our age did not do what was needed as HIV began to destroy the country he loved. But his actions after he realized his failures are an important part of his legacy,” he continues, concluding, “Our greatest ethical leaders like Mandela are never more instructive than when we learn not just from their triumphs, but also from how they recognize and respond to a mistake” (12/8).

Michael Halpern, Huffington Post’s “Science” blog: “It is worth reflecting on [Mandela’s] ability to transcend politics when speaking about contentious scientific issues,” Halpern, a program manager with the Center for Science and Democracy, writes, adding, “Nowhere was this more apparent than in the difficult politics surrounding HIV/AIDS at the turn of the millennium.” He recounts Mandela’s closing address at the 13th International AIDS Conference that took place in Durban, South Africa, and states, “May we all learn from Nelson Mandela’s words and go beyond disagreements about science and politics to confront together the most pressing public health and environmental issues of our time” (12/6).

From the Global Health Policy Community

The following is a summary of two blog posts and a press release published in response to the death of Nelson Mandela on Thursday.

The Center for Global Health Policy’s “Science Speaks” blog: The blog highlights “a joint statement [.pdf] from IDSA and HIVMA on the passing of Nelson Mandela and his lasting legacy to global health,” and provides a number of quotes from Mandela addressing health and human rights issues (Barton, 12/6).

The Global Fund to Fight AIDS, Tuberculosis and Malaria’s “Voices” blog: “With his characteristic big smile, which 27 years of an isolated jail and hard labor could not dampen, he took the fight against HIV to high heights, helping reverse the slow start of response towards HIV in his country,” the blog states, adding, “His wish for a world that transcended stigma and shame that kept AIDS closeted is one that we still grapple with today.” The blog continues, “To defeat HIV, the world needs a Mandela-esque benevolence and resolve to focus attention and interventions in these people who have been pushed away from the center of the society” (12/6).

amfAR press release: “Mandela was instrumental in breaking the silence around HIV/AIDS, and strongly urged the global community to unite in the battle against the disease,” the press release states and provides an overview of his contributions to the global AIDS response. “Witnessing the ravaging effects of the AIDS epidemic across sub-Saharan Africa, the battle against HIV/AIDS became central to Mandela’s mission after his presidency,” the press release notes (12/6).

The Global Fund to Fight AIDS, Tuberculosis and Malaria has published Issue 33 of its newsletter, the “Global Fund News Flash.” The issue highlights the death of Nelson Mandela, examines the Global Fund’s Fourth Replenishment conference held in Washington, D.C., last week, which saw pledges of “$12 billion for the next three years, the largest amount ever committed in this mission,” and notes, “During the replenishment launch, several African countries that implement grants from the Global Fund also pledged to contribute funds as well, as a way to share responsibility and to signal global commitment” (12/6).

In recognition of the 16 Days of Activism Against Gender Violence, USAID’s “IMPACTblog” is highlighting the agency’s work to combat gender-based violence (GBV). In a post published Friday, Diana Santillan, a gender adviser with USAID’s Bureau for Global Health, examines the role of men and boys in changing gender norms and ending child marriage (12/6). In a second post published Friday, Laura Garnett, a program assistant for USAID’s Office of Transition Initiatives (OTI), writes, “Given the breadth and complexity of the issue, USAID’s [OTI] helps increase community education, support for prevention and response, and women’s inclusion in political processes — all critical issues that threaten both the stability and rights of citizens, such as GBV” (12/6).

“On December 2 at World AIDS Day observations in Ghana, His Excellency Vice President Kwesi Bekoe Amissah-Arthur presided over the launch of a new web-based system for reporting HIV-related discrimination” that “will support people living with HIV and other key populations in upholding their rights and fighting discrimination,” Ron MacInnis, deputy director for HIV at the Health Policy Project/Futures Group; Taylor Williamson, health governance specialist with the Health Policy Project/RTI International; and Britt Herstad, regional HIV adviser with USAID’s Office of HIV/AIDS, write in USAID’s “IMPACTblog.” They describe the system and write that its creation “reflects a growing appreciation that discrimination faced by people living with HIV and key populations — including men who have sex with men, sex workers, and people who inject drugs — undermines human rights and quality of life” (12/6).

The Center for Global Health Policy’s “Science Speaks” blog examines a study (.pdf) published recently in the Journal of Infectious Diseases that used mathematical analysis to show “[a]ntiretroviral treatment has provided South African HIV patients 2.8 million years of life from 2004 to 2012, and could provide as much as 28 million years of life otherwise unrealized by 2030.” The blog also discusses an accompanying commentary that “highlights the potential for treatment as prevention and other advances to further advance recognition of how essential continued investment in global health remains” (Barton, 12/6).

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The Kaiser Daily Global Health Policy Report is a free daily publication that provides the latest news and information on global health policy, with a focus on U.S. global health policy and the developments that have important implications for the U.S. global health response.